00:01 Let's go on to another case. 00:03 A 28-year old woman is evaluated for amenhorrhea. 00:06 She stopped taking her oral contraceptive pill eight months ago in order to get pregnant. 00:12 Her menstrual cycle has not resumed. 00:15 She did have normal menses prior to the beginning of oral contraceptives four years ago. 00:22 She also complains of daily nipple discharge over the last six weeks. 00:27 Other than the oral contraceptive pill, she takes no other medications. 00:31 On exam, her vital signs are normal, but she has a white discharge from bilateral nipples. 00:38 Her thyroid, skin, and visual field exam are normal. 00:42 Labs are significant for a prolactin level of 86 nanograms per ml, a normal thyroid-stimulating hormone, and a negative pregnancy test. 00:53 The MRI for pituitary shows a nine millimeter pituitary mass. 00:58 What is the diagnosis? This young woman has secondary amenhorrhea, the production of abnormal breast milk or galactorrhea, an elevated prolactin levels, and a pituitary mass. 01:12 She most likely has a prolactinoma in her anterior pituitary causing secondary amenhorrhea, which is the cessation of menses, despite the presence of normal cycles after puberty. 01:23 Pituitary microadenomas that secrete excessive prolactin cause secondary amenhorrhea due to the inhibition of gonadotropin-releasing hormone in the hypothalamus. 01:34 We would treat these patients with dopamine agonists. 01:37 Bromocriptine is a good first-line agent because of its low cost. 01:41 Cabergoline is better tolerated however because tumor shrinkage is better, but unfortunately, it is more expensive. 01:50 Always check response to therapy by repeating a prolactin level in one month after commencing treatment.
The lecture Pituitary Case: 28-year-old Woman with Amenorrhea and Nipple Discharge by Michael Lazarus, MD is from the course Pituitary and Hypothalamic Disorders. It contains the following chapters:
What is the most likely diagnosis for the patient in the case described below? A 28-year-old woman has yet to resume her menstrual cycle even though she stopped taking her oral contraceptives (OCPs) 8 months ago. She had normal menses before beginning OCPs 4 years ago and also notes nipple discharge over the last 6 weeks. Except for her OCPs, she takes no other medication. Physical examination: Normal vital signs and white discharge from bilateral nipples. Her thyroid, skin, and visual field examination results are normal. Laboratory test results: PRL level of 86 ng/mL, normal TSH level, negative pregnancy test result. Imaging studies: MRI shows a 9-mm pituitary mass.
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